According to a recent report from the advocacy group Oxfam, the U.S. ranked 21 out of 125 countries for its residents’ ability to access a balanced, nutritious diet — which isn’t exactly stellar. But when it comes to the category for the unhealthiest eating, the U.S. plummeted to a deplorable 120.

Now, these rankings don’t focus on gluten-free, free-range, organic fare on fancy restaurant menus. The report, called the “Good Enough to Eat Index” depends on four key measures: the availability, affordability, and quality of food (including access to clean and safe water), plus the prevalence of unhealthy eating habits (based on levels of diabetes and obesity — which are arguably not the most accurate predictors of unhealthy habits). To compile the rankings, the researchers analyzed eight reports from international organizations, including the Food and Agriculture Organization of the U.N., the International Labor Organization, and the World Health Organization.

As the report points out, one clear explanation for America’s high rates of unhealthy eating has to do with what food is available, not just how much. Processed, high-fat foods are often significantly cheaper than fresh fruits and vegetables. Despite many Americans’ efforts to eat healthier, not everyone can prioritize healthfulness over sustenance.

Both in developing and developed countries, millions of people go hungry while others suffer from complications from unhealthy eating. This report is yet another reminder of our flawed food system, both on national and global scales, and the work still to be done when it comes to ensuring people everywhere have access to fresh, healthy food.